Question 1

Hypothalamic hormones (5)

Accepted Answer

1 Growth hormone releasing hormone (GHRH) Stimulates GH and somatotrophs 2 Somatostatin inhibits GH secretion and TSH (by reducing TSH feedback) Inhibits insulin, glucagon, gastrin, secretin, and VIP 3 Prolactin inhibiting hormone (PIH) – dopamine Inhibits prolactin (so does GABA) Corticotropin releasing hormone (CRH) Stimulates ACTH, Angiotensin II and is potentiated by ADH Inhibited by oxytocin 4 Thyrotropin releasing hormone (TRH) 5 Gonadotropin releasing hormone (GnRH) Stimulates LH and FSH surges: Low-frequency = FSH release. High-frequency = LH

Question 2

Posterior pituitary,  the “neurohypophysis”

Accepted Answer

Antidiuretic hormone (ADH), or vasopressin Oxytocin

Question 3

1. Hypopituitarism- 2. Causes: the “nine I’s”:

Accepted Answer

1. Decreased or absent secretion of pituitary hormones ``` 2. Invasive- Space occupying lesions Infarction – Sheehan postpartum hemorrhage Infiltrative - Sarcoidosis (Iron overload) Injury – Severe head trauma Immunologic - Autoimmune Iatrogenic – Medical procedures Infectious – Syphilis, TB Idiopathic - ??? Isolated – Genetic deficiency ```

Question 4

Pathology: Pituitary Hyper-secretion TQ

Accepted Answer

Most common cause: Prolactinoma (Infertility or menstrual changes for women) 2nd most common: Growth Hormone tumor Acromegaly 3rd most common: ACTH pituitary tumors Cushing Disease

Question 5

Prolactin agonists

Accepted Answer

``` Stress Hypoglycemia High levels of exercise Dietary meats Breast stimulation TRH-(ex.hypothyroidism) Sleep Estrogen Melatonin Glycyrrhiza Rauwolfia Phenothiazines Opiates Opioid peptides β-endorphin MAO inhibitors ```

Question 6

Prolactin antagonists

Accepted Answer

``` Free T3 & T4 Vitex agnus castus Vitamin B6 Magnesium Cortisol Progesterone Lycopus virginicus ``` ``` Dopamine (Remember) PGE-1 GABA Acetylcholine (choline) Somatostatin Bromocriptine ```

Question 7

Pathology: Prolactin excess

Accepted Answer

Functional excess: suspect if high E/P ratio, assumed as opposed to diagnosed Medication induced: Tricyclic antidepressants, opiates, haloperidol, Cannabis, Glycyrrhiza, reserpine, OCPs Prolactinoma: small tumor usually presenting with galactorrhea and amenorrhea – referral to endocrinologist and co-management – more soon Diagnostics: serum prolactin and cranial MRI

Question 8

Functions of growth hormone

Accepted Answer

``` Essential for growth in childhood Excess causes acromegaly in adults Has anabolic effects (via insulin-like growth factor) Stimulates thymus hormone release Stimulates gluconeogenesis Decreases glucose uptake and clearance Acts as an insulin antagonist Increases sweating ```

Question 9

Growth hormone’s potential benefits

Accepted Answer

``` Mediated mainly through IGF-1 and IGFBP-3 increases lean muscle mass decreases percent body fat decreases abdominal fat deposition increases the general sense of well-being increases energy lowers cholesterol increases bone density improves short-term memory ```

Question 10

GH agonists

Accepted Answer

``` Deep sleep Fasting Insulin overdose hypoglycemia Exercise High protein meals Arginine, ornithine Estrogen Potassium Dopamine Alpha adrenergic agonists Beta adrenergic antagonists ```

Question 11

GH antagonists

Accepted Answer

``` Cortisol Glucocorticoids Progesterone Fatty acids Obesity Leptin Hypothyroidism Hyperthyroidism Hyperglycemia ```

Question 12

GH measurement

Accepted Answer

GH levels can be indirectly measured by testing for Insulin-like growth factor (IGF-1), also known as somatomedin-C. IGF-1 is a polypeptide hormone that is produced in the liver in response to GH.

Question 13

Pathology: GH Deficiency

Accepted Answer

Congenital “Dwarfism”
Decreased birth length and low growth rate
Short stature, increased fat mass, elevated cholesterol secondary to decreased GH stimulated lipolysis

Acquired
Hypothalamic-pituitary tumor – usually noticeable later in life
Transient GH deficiency in adolescence
Irradiation
CNS trauma

Question 14

Treatment: GH Deficiency

Accepted Answer

Treatment:
Somatropin
Indications: GH deficiency, children with growth failure, AIDS wasting or cachexia, treatment of short bowel syndrome
**Adverse effects (Know This): edema, arthralgia, elevated A1c, gynecomastia, nausea, otitis media, acne, headaches, hypertension…

Currently toted as “anti-aging” therapy for adults, yet is prohibited by US Federal Law if patients do not have GH deficiency.

Question 15

Pathology: GH Excess

Accepted Answer

Congenital “Gigantism” or Acromegaly (Increases risk of CVD) Excess GH secretion pre-puberty = gigantism Excess GH secretion post-puberty = acromegaly Secondary to a tumor or McCune Albright syndrome ``` Presentation includes: Large hands Course feature Thick fingers and toes Large jaw and forehead New onset diabetes Hypogonadism Thyromegaly ```

Hypothalamus, Pituitary and Pineal Gland Flashcards